Thursday, 20 June 2013

It's Brave but is it Helpful?

Angela Gilchrist

Fighting Stigma or
Frightening Stuff?
Photo: Christian Payne

When a celebrity like Stephen Fry can publicly admit
that he's recently attempted suicide and others like Catherine Zeta-Jones
announce they're checking into a clinic for maintenance of a bipolar disorder,
it would be tempting to believe that we've reached a new point in the
acceptance of mental illness.

Certainly, people are more open than they have ever been
about mental distress. Celebrity accounts fill the tabloids and the internet
abounds with stories from those either in the midst of recovery or resigned to
a lifetime of psychiatric input. Films have leading characters with bipolar, MP's have discussed their mental health woes, and we’ve made it illegal to discriminate on mental health grounds. These are signs
that we're beginning to understand mental ill-health as just another form of
distress. Given all this evidence, you could be forgiven for thinking that the
stigma of mental illness is a thing of the past. The reality though, sometimes
seems very different.

In a recent post on this site, Anne Cooke and Dave Harper report on the
relatively unsuccessful Time to
Change campaign, which has failed to alter people's perceptions of mental
illness to any significant extent. The reasons are complex, but research suggests that
bio-genetic causal theories and diagnostic labelling are both related to fear
and desire for social distance. This is distinct then, from the idea of
sufferers experiencing overwhelming distress linked to difficult life experiences.

Courageous as it may be, I would have to question how
useful it is for Fry to admit to wanting to kill himself recently. While we can
feel compassion for anyone in such a predicament, I'm left wondering how
helpful this is for the public. It might well foster sympathy, blighted as he
is by bipolar disorder, but that does not necessarily lead to more tolerance or
enlightened attitudes. On the contrary, it could be argued that those who have
no experience of such things are more likely to be scared stiff than to open
their hearts and minds.

The Deputy Prime Minister, Nick Clegg, admits to having
been moved by Fry's suicide attempt. The public has known for some time about
Fry's struggle with extreme moods, but there is shock and surprise that he
could experience suicidality. Most people have only experienced ordinary
sadness and find it difficult to imagine that there are those among us who
sometimes want to kill themselves. When this becomes apparent, the result is
horrified anxiety or sadly, outright disdain.

How can it be, they wonder, that the witty, urbane and
gifted Fry can seemingly enjoy himself on QI while harbouring desperate and
secret anguish? Twitter threads were indeed informative: ‘What the f--- does he
have to be depressed about?’ tweeted one. Tony Blair’s former aide, Alistair
Campbell, who also suffers depression, had a quick riposte: ‘To those asking
what Stephen Fry has to be depressed about, would you ask what someone has to
be cancerous, diabetic or asthmatic about?’

Well no, they wouldn’t. But despite his diagnosis, the
public clearly wonders why Fry gets so depressed, just as they would be curious
why glamorous film star Catherine Zeta Jones becomes dysfunctional enough to check
into a clinic. Unable to perceive that the wealthy and famous are not exempt
from life's vicissitudes, the public is yet again left with the idea that those
with mental health diagnoses are irrevocably ill and at the mercy of dark
forces. They are 'other' and different.

Fry has also appeared in a video
in which he meets ‘Electroboy’ alias
Andy Behrman –an LA based bipolar sufferer who has written a bestselling book
about his experience of multiple electroconvulsive therapy (ECT) treatments. The
video, currently going viral, contains footage of outdated ECT procedures in
which sufferers are shocked without anaesthetic.ECT is never given without anaesthetic in Britain, but
the public may not know this. Indeed, Fry, who is president of the mental
health charity Mind, admits on film that
he was unaware that people with bipolar mood swings are prescribed ECT. But
does this potentially frightening film clip really help to break down stigma?
Or does it scare the public as well as stigmatise those who have had ECT, or
may receive it in future?

We know from research that the poor are far more likely
to suffer mental health difficulties because their lives are stressful. But if
the rich and gifted admit to being overwhelmed and unable to take possession of
themselves as a result of mental disorder, then how much more likely is this
for the average sufferer, the public reasons. Revelations may well increase
public sympathy and invite further disclosures, but it seems there is little
evidence that they have a positive impact on discriminatory practices or the
public mindset.

So should celebrities keep quiet? Far from it. Disclosure
and openness are merely a first step. We need to go further and help the public
break down fears and ignorance. But to do that, celebrity sufferers should think
carefully about the messages they are putting out and how they will be
received.

The actress Glenn Close, who recently revealed that her
sister has bipolar disorder and has
begun a charity in her honour, admits to wishing she had paid more attention to
mental illness when she made the movie 'Fatal Attraction'. She confesses to
having fed into the idea that people with mental health issues are dangerous,
in her one-dimensional portrait of bunny
boiler Alex Forrest.But when Close's sister became ill, the actress was able
to see things differently. It's
happened to my sister and so it could happen to me.

Here, then seems to lie the answer. There is evidence
that people are able to change their attitudes to mental illness when they
personally know someone who suffers from one. It is experience and closeness to
mental health difficulties that crashes the barrier. And it is an understanding
of mental health issues often being the result of extreme experiences such as
poverty and trauma that fosters compassion. Celebrities, either out of the
closet or on their way to being so, might want to bear it in mind.

15 comments:

I categorize public figures into two categories, those with courage and those without it or at least less of it. In my eyes, anyone who conceals their bipolar illness is a coward. Admit that you, a perfectly good person, has this neurological disorder so that awareness increases and stigma decreases. Courageous, honest public figures: Stephen Fry, Carrie Fisher, Demi Lovato, Sinead O'Connor, Andy Behrman. Those not admitting to being bipolar: Charlie Sheen, Lindsay Lohan, Amanda Bynes. Catherine Zeta Jones kept it hidden for years.

Gina, I don't think anyone is questioning Stephen Fry's honesty of courage. It's more a question of whether the way he is offering his experience is helpful and actually works to combat stigma. I'm not sure it always does.

I agree that disclosures like this may be confusing and unsettling for some people who have had little contact with 'mental illness'. However, I can imagine for people who have similar diagnoses and have faced similar types of distress or know people who have, it could feel de-stigmatising and less isolating to know that other, celebrated, intelligent, successful people also suffer from similar difficulties. I believe that high achievers such as Fry can also challenge stereotypes of the 'sick' role. Having said that, it does make me feel uncomfortable when public figures reinforce notions of illness where people are powerless to do anything about their experiences other than going to see a psychiatrist and taking pills, which I think was the message Fry got across. I think what we need is more public figures speaking out about alternative ways of thinking about distress so that more empowering discourses around psychological distress are created.

Good point John - those who are unfamiliar with bipolar disorder may be frightened by stories from bipolar individuals that are similar to Mr. Fry's. Hopefully, however, the uninformed use it as an opportunity to increase their knowledge of mental health issues.Yes Becky - Whenever a celebrity with mental health issues opens their mouth and speaks words that inform the public of mental illness, I, as someone who is bipolar, literally cheer. I've had less explaining to do as a result of Demi Lovato's candid attitude in particular. She's significantly increased awareness in my age bracket.

I think my reaction is: how can talking openly, honestly, and with grace, about one's own human lived experience be wrong?

I think above all what the psychology vs psychiatry debate needs is lots of diverse voices talking about their own, diverse, experiences.

This site published some strong pieces by someone, vivdly describing liberation from diagnosis. Freedom to frame our experiences in our own way is vital. But shouldn't that freedom extend to Fry, too? Many service users, after all, do subscribe to the mental illness model, and find diagnosis helpful.

I felt uncomfortable about Fry's disclosure but wasn't sure why. I recall that in the past, he had said that he didn't take medication for his difficulties. Which made me wonder what message he was giving to other sufferers. I ran a group for people with bipolar disorder and that was one thing that those in the group remembered him saying. They felt that they too should be able to cope without medication. I noticed in his recent disclosure, however, he said he is on meds now. Celebrities have a huge responsibility and need to very carefully consider the messages that they put out. While I think that being open and honest about ones difficulties takes great courage, I think it remains a tricky business.

I don't know how many read accounts of what Stephen Fry said publicly, or even heard the interview, but I have just found myself having to check where 'this story' started. For I believe that we cannot divorce the fact that, even if Fry is President of Mind (a title that I did not know existed before he had it), he is partly speaking for his career in what he chose to say to Richard Herring, and when, and where, and how.

Then again, Fry is partly talking about (attempted) suicide as something affecting other people, too, but what I was most aware of was Alastair Campbell, if not putting his celebrity mental-health spin on the topic, by (as quoted above) suggesting the absence of a reason for feeling suicidal, then at least chiming in with a message that essentially says That's just how it is.

Whether, if The Samaritans had metaphorical hair, they would be pulling it out, I don't know, but I do not feel that the combination of Fry's revelation and Campbell's comment encourages anyone to believe in a world where picking up a phone and talking free and freely to a non-judgemental stranger might give a different perspective on what I, rightly or wrongly, characterize as despair.

This, however, is where I have already taken issue with Fry (on my blog), because I do not believe that depression is ever and always just like the weather, and that one has to sit out, as best one can, the dark, gloomy days until they pass, and the sun shines again :

It certainly isn't an easy route to remember to apply what psychologists such as Paul Gilbert say and fight against negativity and negative thinking, when one feels like curling up in a ball and hoping for death, rather than re-evaluating one's feelings, seeing what maybe questionable thoughts have come from them, and how they, in turn, have lowered mood.

And, no, it doesn't always work, but I now have the experience of things that I could ordinarily have expected to drive me down looked at in a new light, and, with care and comfort, nourishment and being kind to myself, of having coped less negatively and injuriously with them.

Not, however, that I would then have spotted, except at the other end of that tunnel of just not wanting to have to be and experience, and of just being immersed in eventually refreshing sleep, where those two to three days being wasted came from, but the seed of all proved to be caable of being wormed out after the event.

None of this new approach prevents catastrophic collapses of confidence and of the capacity to comfort, rather than going into a spiral of negativity where nothing has ever been or ever will be good enough, but it is making a difference, so I will not subscribe to Fry wanting to say that depression just happens, or Campbell that suicide is beyond reason, inexplicable.

Liz - When celebrities who have mental health issues stop taking meds and don't want to discuss meds, they're putting stigma on those who do take meds. Nobody wants thier sanity to come from a bottle but sometimes that's what needs to be done. If any celebrity such as Fry wants to be an advocate, they need to gain an understanding of this point.Agent Apsley - Sometimes mental illness just is. I am a cheerful, upbeat person by nature and sometimes my brain chemistry goes haywire and I find myself depressed. There aren't always psychological causes, believe me. They can make things worse but in my opinion, they are far from being the cause of my bipolar mania or depression.

No, I know - from experience - that there either aren't causes, or ones that I can rationalize the negativity out of, but sometimes there are are, and then the help of friends, of what I learnt from a very good psychologist, can help me not beat myself to a pulp. Sometimes.

I'm not averse to celebrities disclosing their mental health condition because bringing it into the public domain can only help to demystify and 'normalise' it, thereby encouraging discussion and awareness which may be of help to non-celeb sufferers and their friends and family and encourage them to seek help without fear of being stigmatised.

I was diagnosed bipolar in my late teens. Symptoms were severe and I was heavily medicated for a few years. I was off meds for about 15 years then suffered another episode treated with anti-depressants. Episodes became more frequent and I've decided to stay on medication rather than mood swing. Extraordinarily, friends with no medical training think I should strive to come off ADs as if I take them for recreational use.

I'm recovering from thyroid cancer and this has seriously messed with my head. It's hard to know where the thyroid low mood starts and the bipolar mood swings begin. I'm not sure the ADs I take are entirely appropriate but there's no point messing with them until my throid replacement is optimum.

I bet my friends won't nag me to stop taking thyroxine every day though. It's anti-depressants they have prejudices about.

Great post. Very good questions are asked. I am not sure how celebrities talking openly about mental illness helps fight stigma except that maybe it makes people want to learn more about it. Maybe it shines light on the fact that mental illness sufferers don't all look like scary, mean, dirty, disheveled people. I have actually run into people that tell me I can't possibly be mentally ill because I look so normal. Duh. What I can attest to is that celebrities speaking about their mental health issues help us that suffer feel like we are less alone. It shows us that we can be doctors, presidents, inventors, actors, singers, comedians. That we can be writers and directors. That we are everywhere. I find it courageous that these people have spoken up about a very personal topic and choose to share it with the world knowing that they are going to be ridiculed by some for doing so. Just like when we the non famous mental illness sufferers do. It's hard. It's scary. It needs to be done. If a celebrity does not take medication then that is their choice, right or wrong. We can simply realize what is best for us personally may not be what is best for another and we need to take advice from our doctors rather than celebrities that don't know us personally.Every time a celebrity comes out as having mental illness it helps our self esteem in some small way. If Fry is willing to talk about than maybe it's ok for me to talk about it as well. As we become more confident and start to speak about mental illness, does that not help break down stigma? When Westland up for ourselves and we educate does that not make it easier each time to talk about it? I believe that celebrities talking openly helps but maybe not in the way you think it would. Maybe it helps break down stigma not by making"normal" people listen but by making the mentally ill more courageous, more confident, more aware that we can talk about it and thus end stigma a conversation at a time.

No it isn't helpful nor brave compared to ordinary service users using NHS mental health services as compared to the Priory, facing instability with housing and Atos assessments. See my comments on this blog under Joanna:http://thesecretlifeofamanicdepressive.wordpress.com/2013/06/05/stephen-fry-suicide-and-the-cycle/

About the Salomons Centre

The Salomons Centre for Applied Psychology in Tunbridge Wells, England. We are part of the Canterbury Christ church University Department of Psychology, Politics and Sociology. We run training courses in Clinical Psychology and CBT and also practice improvement programmes for child and adolescent mental health services. On this site staff and trainees in the Department write about a wide range of issues related to applied psychology, psychological therapies, policy and health service development.